ESC GUIDELINE

STEMI
• ECG criteria for STEMI (at least
two contiguous leads with ST-
segment elevation)
• Anterior MI (in leads V2–V3 )
• 2.5mm in men < 40 years,
• 2mm in men >40 years,
• 1.5mm in women
• Lateral and Inferior MI  1mm
• Inferior MI  right precordial lead
(V3R, V4R)
• Posterior MI (V7-V9)  0.5mm
STEMI EQUIVALENT

NEW LBBB
Sgarbossa Criteria
(score >3  MI)
STEMI EQUIVALENT
STEMI EQUIVALENT
STEMI EQUIVALENT
Patients with MI and right bundle branch block
(RBBB) have a poor prognosis. It may be difficult
to detect transmural ischaemia in patients with
chest pain and RBBB.

Therefore, a primary PCI strategy (emergent

coronary angiography and PCI if indicated)
should be considered when persistent ischaemic
symptoms occur in the presence of RBBB.
BIOMARKER
• Myoglobin
• CKMB naik di jam k3  puncak jam k12
• Hilang di hari ke 5-6
• Cocok untuk menilai Reinfarct
• Troponin mulai naik di jam k3  puncak jam ke 12-24
• Normal di hari ke 8-21 (Trop T)
• Normal di hari ke 7-14 (Trop I)
Dosis Fibrinolitik
• Streptokinase 1.5 juta Unit dalam 100cc NaCl 0.9% atau D5%
diberikan secara infus selama 30-60 menit
• Amati tanda-tanda (PAHA)
• Perdarahan
• Alergi
• Hipotensi
• Aritmia
Peniliaian keberhasilan Fibrinolitik
• Setelah 60-90 menit fibrinolitik, dinilai keberhasilannya
• Bila fibrinolitik gagal  PCI
• Tanda keberhasilan fibrinolitik
• Resolusi komplit nyeri dada
• ST elevasi turun >50%
• Terdapat aritmia reperfusi
Agen fibrinolitik lainnya
Dosis pada
pasien CKD
• Early STEMI 0-12 hours
• Evolved STEMI 12-48 hours
• Recent STEMI >48 hours